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Monday, April 8, 2013

MiM Mail: Didn't see this coming

Dear MiM,

I've been following your posts since before I began Medical school! I'm currently an M3, my journey has been far from traditional. I put my medical school dreams aside after college to help out at home and take care of my mother. Fast forward many years and I began my medical school career at 33 as a daughter, wife and mother of two gorgeous little girls (5 and 2 at the time). It has been a lonnnnnng road needless to say. Just three years later, I face M4 year and residency as a single mother of two living back home with my mother. The ex's insecurities (non-medical) and later infidelity became too much to bear. Although, he is a phenomenal father - very hands on and picks up a lot of the slack.

So, to my current state! I'm two clerkships shy of completing 3rd year and have yet to find my "calling." I absolutely loved OB and I keep saying if I were single and 10 years younger, I would totally do it. I love EM, but do I really want to put the girls through not having their mom so much at nights, weekends and holidays? I felt as if FM didn't get the respect that they deserved, and going through one more day of rounds in IM would have been the end of me! Psych, so help me God, if I fell for one more drug addict's story, I was going to institutionalize myself. Peds left a sour taste in my mouth due to the company....

So now what!? I apologize if I offend anyone, I'm just trying to be honest and show you a glimpse of the million things in my brain. I need to be moving, I love variety, and I'm a hard worker! But let me be honest to myself! I'm 36 and I'll be almost 500K in debt when we graduate! What's going to pay the bills, provide my daughters with a mother, and allow me to be a great physician?

After residency is over, my oldest will be 12 and youngest 10. So much time they and I have sacrificed and for what!? For their mother to have no clue how she's going to move forward alone and completely in debt? Did I mention the divorce lawyer said I'm confined to my state for residency or risk losing the girls? As if finding a residency wasn't hard enough.

I just need advice. I have no idea what to do. I've kept it together this long and now the pressure to make a decision on a career seems to be putting me over the edge. I just didn't know the amount of sacrifice medical school would entail. I know there is always light at the end of the tunnel...but at this point I would have never done this had I known. Obviously my love for the field was more than my love for my marriage because I chose medicine over it. The question now is: how do I make all the sacrifice pay off? I need direction and I can't talk to my 26 yo single friends who make it seem so simple. For them with no responsibilities, it is! At this point I just feel like I've been a completely selfish person having decided to ever pursue this and I feel obligated to pick a field that will help me start repaying my time lost with the girls. Is that even possible?

22 comments:

EM. It's lucrative, and it's shift work. Your kids can spend some holidays and weekends with their father, and the rest with you since you won't work every single weekend and every single holiday. Maybe you can cut it down to part-time when you've finished residency.

I know. Wouldn't it be awesome if there were some residency where you had like 9 to 5 hours every day, took call only from home, and only worked maybe 3-4 weekends the whole year? And paid really well upon graduation. And wasn't hella competitive like derm or rads?

$500K would be a huge burden. Have you learned about repayment options for federal loans such as Income Based Repayment (IBR)? After 10 years of payments and working at the right types of practice situations, the balance is forgiven. At 500K, I imagine you have some private loans, and I don't know how those would factor into the repayment picture. Do you have a financial advisor available at your school who can help you understand your options?

The people who benefit are those with huge debt who spend long periods working in jobs with low salaries, because by definition those with higher salaries do not qualify for income-based repayment. When the tax bill comes due, I believe the unpaid balance is counted as income, so anyone with even a moderately high salary would be slammed with hundreds of thousands of dollars in taxes in a balloon payment. This program probably would not be of any help to the OP unless she is planning a long career as a rural Family Practitioner.

Another group that could benefit would be those with long residency or residency plus fellowship. People with 7 years or so of resident/fellow salary and large debt going into training could have a significant portion written off. And yes, there would be the tax on the forgiven amount at the end, but that would have to be less in the long run than continuing to pay the balance plus the interest current students are facing. Federal loans at 6.9% without a way to aggressively pay them off can easily double during the life of the loan.

According to the IBR website, it looks like eligible students must make payments for 25 years unless they qualify for 10-year public service loan forgiveness. I suspect very few residencies would qualify as public service for the purposes of the program.

EM! Have a wonderful friend (widow mother of 2) who is loving her life. She sent me plenty more pics of her having quality time with kiddos than I get with my little one. Now she is working, and probably making slightly more than any of the offers I have coming in, for half the hours. (I'm PGY3 FP, feel plenty respected and LOVE my job - can't wait for the real one to start so I can have my life back.)

Don't beat yourself up about being selfish. All of us are sooo selfish for working our buts off to take care of everyone but ourselves. Your ex is the one giving you those thoughts. Be proud of the work you have accomplished and find a path that makes you a happy person that way you can be the best mom.

I am also an MS3, your rotation experiences sound like it could have been written by me (especially the part about IM rounds). I love surgery but I am also older and I dont think a surgical residency would be fair to my family (I am married and expecting my first). I am planning to apply in EM which I also love.

To echo what's been said above, it sounds like you really like EM. EM, at least at my institution, is full of people who loved Ob, but didn't want to inflict a surgery residency upon themselves. Either that or Anesth. Good luck! You're lucky you like so many things!

EM! I'm an EM doc and full time allows me to have at least half of the month off to spend at home with my little girl. I work 13 to 16 shifts per month, and make more than enough to support my family and pay off my loans. Working some weekends and holidays isn't bad when ou get to have a lot of weekdays off and usually only work 2 to 3 days in a row. I can easily take vacation when I want as long as its planned a little in advance and I'm never on call. And you could easily work part time and still make really great money. Good luck in whichever field you choose! It's a long road, but hang in there. It will pay off in the end.

While I find path to be a great lifestyle/financially supportive choice as a single mother, I don't know if running to OR to do frozen sections or back and forth to radiology to do wet reads on interventional needles would satisfy your need to be "on the move." Sounds like you are more of a patient-based clinician. I didn't quite have your level of loans, but I have been able to whittle them down slowly over the last 6 years to under 20K. I was lucky to start off a little less than 100K. State school and financial support from family helped a lot. But I know plenty of people in their mid-40's who are still stressed about not having started saving for their kids based on ginormous school loans - college and med school. You are not alone.

As a single mom, I want to chime in here to give you support in that arena. If you have great help for kids from your ex, as I do with their dad and stepmom, it really makes sense to stay in the area, divorce lawyer or no. Good for kids, good for you. Hopefully this will give you enough choices. A full time residency is going to require lots of support, and having family around is key.

It sounds like you feel (at least in this letter) that your love for medicine was at least partly responsible for the failure of your marriage. I know everyone's situation is different, and career can be a stress on a marriage, but a lot of things in life stress a marriage and I wouldn't blame medicine (i.e. yourself) entirely here. From where I am sitting, three years out of a failed 13 year marriage (how can you call it a failure when you look at your kids, right?), it was more youthful, immature decision making and mismatched personalities that led to demise of mine. I know plenty of people that cook along in unhappy marriages, finding themselves regretful in their 50's after their kids went to college. You are career-oriented, independent, and love your kids. How can that be a bad example, overall? As many of these lovely, happily married MiM's can attest, you don't have to choose medicine over marriage/relationship. They can work together. There is hope for the future.

Good luck in finding a spot to fulfill your needs in medicine and spend as much time as you can with your kids. Sounds like EM has the majority vote. I often wished I liked EM - I envied the shift work of the med tech mothers in the lab and I think EM offers the same freedom. I am sure it has it's challenges, but I know plenty of dads and moms in EM that have lots of time to spend with their kids.

I just wanted to start off by thanking everyone for their words of encouragement and great advice. At this point I'm 1 rotation away from becoming an M4 and this couldn't come at a better time. I wanted to make a correction to my original post as I will only be in debt 270K, I have NO idea why I wrote 500k, I blame sleep deprivation. Again thank you all, I know all of you have made it and that in itself gives me great hope.

As a medical student I got many thing to learn from this blog.The posts of this blog is very informative and I always post interesting information.I thank to the author and hope will get more useful post.Pharmacology

Consider family medicine. Community programs offer so much more respect and so does the real world. University settings are not where most of medicine happens anyways. You still have three years of residency, but now I work three longish days a week and make a very reasonable salary. I am very proud of what I do, find each day interesting and challenging, and I get to be there for breakfast and dinner every day.

Wish I had found this website sooner! I, too, am an MS3 struggling to choose a specialty that will be both fulfilling as a career and allow me maximal time with family. I am (I think!) down to EM vs Med-Peds and think that overall M-P would be a better fit for me since I'm thorough and enjoy talking with patients, but I feel that EM would be a be an easier path (read: I'm dreading any more 6-days-a-week-12-hrs-a-day wards months, even if I did enjoy both inpatient peds and medicine), and it would probably allow me more time with our future kids. I like higher-acuity care and worry that I might be bored doing primary care, but I'm not sure I want to work the hours of a hospitalist or put additional time into a fellowship. Can the physician-moms reading this attest to how important continuity of care is in their practice? I worry that if I choose EM it may be unfulfilling for that reason. Is it short-sighted to avoid M-P largely because the 4 years of residency is intense?? Thanks!

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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